U.S. study shows older homeless at greater risk of dying

SAN FRANCISCO, Aug. 29 (Xinhua) -- Older homeless people are more likely to die than those who had become homeless earlier, according to a study published on Monday by University of California San Francisco (UCSF).

People who first became homeless at age 50 or later were about 60 percent more likely to die, and their risk of dying was three times higher for men and five times higher for women, compared to general population of the same age and sex, said the study.

By interviewing people every six months about their health and housing status, researchers were able to examine how things like regaining housing, using drugs, and having various chronic conditions, such as diabetes, affected their risk of dying.

The study, funded by the U.S. National Institute on Aging, recruited 450 people who were 50 and older and homeless in northern California's Oakland, and followed them for a median of 4.5 years.

Participants entered the study in two waves, with 350 enrolled from 2013 to 2014 and another 100 enrolled from 2017 to 2018.

The median age for participants entering the study was 58, and 80 percent were black. 76 percent were male, and 24 percent were female.

The study shows that a quarter of the participants died within a few years of being enrolled. As of Dec. 31, 2021, 117 of the 450 people had died since the study. Among them, 101 of the deaths were from the first wave, and 16 were from the second.

The median age of death was 64.6 years old, and the most common causes of death for people in the study were heart disease (14.5 percent), cancer (14.5 percent), and drug overdose (12 percent).

Nearly 40 percent of deaths occurred after the pandemic started in March 2020, but just three of those deaths were from COVID-19.

"Homelessness was a risk for everyone, and those who remained homeless were about 80 percent more likely to die than those who were able to return to housing," the study said.

The study is unique for its prospective design. Previous studies of mortality in homeless populations were retrospective and drew information from medical records. By contrast, the current study -- Health Outcomes of People Experiencing Homelessness in Older Middle agE (HOPE HOME) -- followed a group of people, whether or not they received health care, while many study participants had serious conditions that went untreated.

"We looked at how frequently people reported diagnosis of heart disease or cancer before dying of these diseases. It was really low," said Rebecca Brown, affiliated assistant professor of medicine in the Division of Geriatrics at UCSF. "We think this represents a lack of access to care and delayed diagnosis. Often, we didn't even know people were ill because they didn't report it in their six-month interviews. But we found it on their death certificates."

"Becoming homeless late in life is a major shock to the system," said Margot Kushel, who directs the Benioff Housing and Homelessness Initiative and who is a professor of Medicine at UCSF and senior author of the study published in JAMA Internal Medicine.

"These untimely deaths highlight the critical need to prevent older adults from becoming homeless -- and of intervening and rehousing those that do, quickly," she added.